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HealthPayerIntelligence News

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

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As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In an...

Single-Employee Businesses Experience High, Burdensome Premiums

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Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals....

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

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Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve its...

Payer Housing Programs Address Social Determinants of Health

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Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

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Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

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AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group believes...

11 Healthcare Payers to Enhance Substance Use Treatment Access

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Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

Top 5 Most Common Healthcare Provider Fraud Activities

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Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants in...

44% of Employees Don’t Know Value of Health Plan Benefits

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Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Payer Strategies for Improving Member Medication Adherence Rates

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Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to adherence. Avoidable healthcare spending totaling between...

Providers Caught in Medicare Fraud Schemes Topping $200M

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Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law enforcement...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

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As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to engaging...

Maine Referendum Expands Medicaid Despite Governor Opposition

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The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

More Choices for Federal Health Plans Doesn’t Spread Market Share

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The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

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CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in an...

Why the Generic Drug Market is a Growing Payer Opportunity

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As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

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Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

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ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

Emergency Response Devices Add Value to Medicare Advantage Plan

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Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in several...

3 Value-Based Pharmaceutical Contracting Options for Payers

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Value-based pharmaceutical contracting offers health payers the option to lower drug prices while improving patient outcomes. These contracts come in several different forms, according to Dr. Surya Singh, Chief Medical Officer of CVS Specialty,...

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